persistent right side pain for 5 months

[circle]

Hello,
I have been experiencing an almost constant pinching sensation in my right side for about 5 months. Similar to a cramp, or being jabbed with a thin, blunt instrument. It is located between my hip and lower rib cage, and often slightly higher, beneath the ribs. It occasionally radiates to the back as well.

Sometimes the pain seems definitively worse when I take certain medicines - such as Zoloft, which I tried for a week; but it is also much worse when I sit down. I also tried darvocet at one point, and that seemed to make it worse. It is almost constant, and extremely annoying. Sometimes adjusting my posture offers slight and temporary relief. I am a smoker, 31 years old.

I have had:
CT scan
gallbladder ultrasound
torso x-rays
HIDA scan
colonoscopy
endoscopy
liver enzyme tests

The only unusual result was in the endoscopy, which showed some stomach irritation; gastritis, I suppose. One of the liver enzymes was slightly raised - 55 instead of 51, I think; but I've been checked again since.

On one occasion about 3 months ago, I went to Urgent care because of sudden severe, right-side, lower abdominal pain - different from the persistent problem mentioned. I had my appendics out about 10 years ago, but I thought this incident  might be a hernia or something serious. Almost a surgical pain. The doctor thought it was intestinal blockage and sent me to the emergency room. No blockage, so I was sent home and referred to a specialist. That was the only incident of significant abdominal pain in that lower region.

One doctor suspected rib inflammation and I tried lodine for a couple of weeks, which might have helped a little, but the symptoms are still consistent with digestive issues. The specialist that I'm seeing suspects an ulcer now, and I'm taking carafate. I trust his judgement, but from my own subjective viewpoint it just seems unlikely to me that an ulcer would manifest itself as this type of pain that is so isolated in my right side.

When I wake up in the morning it doesn't hurt, but soon after I've been sitting down for a bit, the pain begins. It is significant and distracting to the point that when I'm sitting down, it is hard to think about anything except lying down or standing up to relieve the discomfort.

Any suggestions on what I should do? If it is related to smoking, wouldn't something have shown up in one of the tests?
Could a muscular pain be at all related to dietary issues, such as the fact that the pain is worse when I take certain medications? Could an ulcer manifest itself on the middle, right side of abdomen?

I greatly appreciate any advice you can give me.

[Kevin Pho, MD]

Tough to say - you have had a pretty comprehensive evaluation.  One consideration would be small bowel inflammation (i.e. Crohn's disease).  The small bowel is sometimes difficult to evaluate since it lies right in between the range of an upper endoscopy and a colonoscopy.  One consideration would be an upper GI series with small bowel follow-through, which can sometimes detect any thickening in the small bowel.

It is possible that an ulcer can present in the right side, although it is less common.  Another possibility would be irritable bowel syndrome - where antispasmodic agents may help.  

If the GI options have run out, then yes, I would consider musculoskeletal causes as an option.  A referral to a physiatrist (rehabilitation specialist) can be considered.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[Biskie2]

Did your testing show anything for Pancreatitis? Have you had a complete chest x-ray?

[circle]

Yes, pancreatitis was the first thing my doctor suspected; and I had front and back chest x-rays at the Urgent care and at the hospital.

[circle]

Sorry, my first answer wasn't clear: he suspected pancreatitis but apparently ruled it out.

[emptyvoices]

You know, I had symptoms similar to that plus all of those tests including a small bowel follow through, two colonoscopies, cat scans, etc.  I'm just wondering if you had any unusual weight loss, weight gain....I would have your thyroid checked...as off as that sounds, if you have an autoimmune disorder affiliated with your thyroid, it can open you up to other indicators.

I would also check for something called Yersinia which is sort of like food poisoning that mimicks Appencidicitis...the test is simple for it and it's just a course of antibiotics to get rid of it...strong antibiotics but yersinia can mimick crohn's, appendicitis.  It's just my advice through my experience.  I would see your doctor for options. At this point, do a range of these tests.  Don't give up.

[circle]

Thanks for your comment.
My weight has been consistent - would a thyroid problem necessarily be indicated by a change in weight? I actually had a doctor suspect thyroid in the past - about 5 years ago - and the test was borderline abnormal.
Did you find anything out from all of the tests that you had?

[Biskie2]

You may want to try Pepcid AC (1x day). I had pains like that for 1-1/2 weeks straight and went to Gastro and he felt around my abdomen and said it wasn't a blockage, etc., and that it would probably pass. If it didn't, he would do an upper GI with small bowel follow-through. Couldn't sit for a long time - had to keep on getting up and stretching it out. Wouldn't you know it, the day after I saw him, it went away completely. And I have not been taking any Pepcid AC since. Get your thyroid checked (TSH blood test) - if you have weight gain/loss, very dry skin around fingers/hands, tired, etc. Don't think the thyroid is responsible for your current problems, however. Good luck.

[chatzi]

I have had persistent, nightly pain in the upper right quadrant of my stomach for several months. I have had ultrasound, cck-hideascan, rib xray, and am going for colonoscopy this week and bone scan as soon as I can get appt. The pain wakens me during the night and lasts one to three hours - it abates after much belching and rectal gas. The pain feels like a hot poker in my upper stomach - when I get up I feel some relief. During the day I have soreness in that area both internal and external. Any thoughts

[jenna-anne]

Hi

Not sure but I think it might be the zoloft.  Have just started taking it and have the same sharp, jabbing right side pain that you describe.

[outbackman]

A related discussion, right side pain was started.

[oscarmoscar]

A related discussion, right side pain was started.

[bobby604]

A related discussion, gasteroid was started.